Texas is the most important state on this list for one reason: in 2025 the Legislature extended its statutory limits on health care non-competes to dentists. Senate Bill 1318 put hard numbers on duration, geography and buyout price for practitioners who had previously been governed by general common law reasoning. If you are an associate or an owner in Texas, that single change probably matters more to you than everything else on this page.
Key takeaways
- Under Senate Bill 1318 (89th Legislature, effective September 1, 2025), the health care practitioner non-compete provisions were extended to dentists, nurses and physician assistants. A covered non-compete must expire no later than one year after termination, is limited to no more than a five-mile radius from the location where the practitioner primarily practiced, and the buyout may be no greater than the practitioner's total annual salary and wages at termination.
- Dentist CE is 24 hours biennially, with at least 16 hours in technical or scientific coursework directly related to clinical patient care and up to 8 in risk management topics. A human trafficking prevention course approved by the HHSC executive commissioner counts toward the 24.
- The Texas jurisprudence assessment is required every four years and does not count toward the 24 CE hours.
- A dental assistant who positions or exposes dental x-rays must hold a dental assistant radiology certificate from TSBDE. Machine registration is a separate matter handled by DSHS, where a new x-ray certificate of registration application currently runs $370 and fees are paid biennially.
Rules change. Everything below was verified against an official Texas or federal source in September 2026. Fees, CE rules and statutes change, and the non-compete provisions are new enough that courts have not fully worked through them. Confirm with the agency and with counsel before acting.
Who regulates what
| Topic | Agency | Official link |
|---|---|---|
| Dentist and hygienist licensure and renewal | Texas State Board of Dental Examiners | Dentist license renewal |
| Dentist continuing education | Texas State Board of Dental Examiners | Dentist continuing education |
| Dental hygiene and dental assistant scope | TSBDE, Dental Practice Act and board rules | Dental Practice Act and TSBDE rules |
| Radiographic operator requirements | TSBDE (dental assistant radiology certificate) | RDA x-ray certification |
| Dental x-ray machine registration | Texas Department of State Health Services, Radiation Control | Dental x-ray machine registration |
| Radiation laws and rules | Texas DSHS Radiation Control | X-ray laws and rules |
| Infection control in the dental office | TSBDE (plus federal OSHA) | Dental Practice Act and TSBDE rules |
| Amalgam separators and dental wastewater | US EPA rule, enforced through your local pretreatment control authority | EPA Dental Effluent Guidelines |
| Equipment disposal | Texas Commission on Environmental Quality (DSHS directs disposal questions there) | TCEQ |
| Corporate practice and practice ownership | TSBDE rules plus entity filings with the Texas Secretary of State | Dental Practice Act and TSBDE rules |
| Sales and use tax on equipment | Texas Comptroller of Public Accounts | Texas Comptroller |
License renewal and continuing education
TSBDE publishes a 24 hour biennial CE requirement for dentists, with a structure rather than a flat number:
- At least 16 hours in technical or scientific coursework directly related to clinical patient care.
- Up to 8 hours in risk management topics such as recordkeeping, HIPAA and ethics.
- Up to 8 hours may be self-study formats, including video, audio, correspondence and reading.
Mandatory content sits inside that total. A human trafficking prevention course approved by the executive commissioner of the Texas Health and Human Services Commission is required as part of the 24 hours. Dentists holding a DEA permit must complete 2 CE hours on prescribing and monitoring controlled substances and 4 CE hours per renewal on safe and effective pain management related to the prescription of opioids. Those hours may count toward the 16-hour technical requirement.
Separately, the Texas jurisprudence assessment is required every four years and does not count toward the 24 hours. That is the requirement most likely to be forgotten, because it runs on a different clock than renewal.
CPR is accepted as CE. ACLS and PALS may count only for sedation permit holders. Up to 24 extra classroom hours from the prior year may be banked forward. The board audits roughly 5 percent of renewals each month, selected at random, so keep certificates rather than relying on a provider's portal.
X-ray equipment: registration and inspection
Texas DSHS Radiation Control handles registration through its Radiation Machine Source Unit, and it publishes concrete dollar figures, which is rare.
To get a new dental x-ray certificate of registration you file:
- Form RC 226-2, the radiation machine application
- Form RC 226-1, the business information form
- Form RC 42-R, the radiation safety officer form
- The application fee, currently $370 for a new certificate
Additional use locations carry a 30 percent premium per site, and reciprocal recognition is also $370 for two years. Biennial fees must be paid every two years to continue operating x-ray devices. Equipment, name, address and radiation safety officer changes can be submitted through the DSHS Regulatory Services online licensing system or by filing RC 226-2 with a description of the change.
Note the radiation safety officer form. Texas wants a named individual on file, which means a practice that hires and loses an office manager who held the role has a filing to make, not just a staffing gap.
DSHS directs equipment disposal questions to the Texas Commission on Environmental Quality rather than answering them itself. That is a useful piece of routing to know before you call the wrong agency.
DSHS does not publish a dental inspection interval on the dental x-ray page, so confirm it with the Radiation Machine Source Unit. DSHS does publish a dental-specific regulatory guide (Regulatory Guide 4.4), which is the document to hand a new office manager.
Who may take radiographs
Any dental assistant who positions or exposes dental x-rays in Texas must hold a dental assistant radiology certificate from TSBDE. There are two qualifying paths: complete a TSBDE-approved dental assistant course and pass the associated examination, or hold a current Dental Assisting National Board certificate and pass the TSBDE jurisprudence assessment within one year of application.
On top of that, applicants must complete a current hands-on basic life support course, hold a high school diploma or GED, complete a human trafficking prevention course, and pass a fingerprint background check. Initial registration periods run 18 to 30 months, and renewal reminders go out roughly 60 days before expiration.
When you hire an experienced assistant from another state, assume the credential does not transfer and start the TSBDE certificate process on day one. A DANB certificate helps, but it still requires the Texas jurisprudence assessment. Plan your radiography coverage around the gap.
For general mechanics, see dental x-ray registration and inspections, and the equipment pages on intraoral x-ray units and panoramic units.
Buying and selling used equipment in Texas
Registration and changes
A new dental practice in Texas files for a certificate of registration and pays the application fee. An existing practice that adds, removes or replaces a machine files a change, either online or on form RC 226-2. If you are opening a second location, remember the 30 percent per-site premium on additional use locations, because it is easy to forget when you are budgeting a satellite office.
Ask the seller of any used unit or practice for the current certificate of registration and the machine list. Compare it to what is in the building. The RSO on file should also be checked, since a certificate naming someone who left the practice three years ago is a signal about how the rest of the compliance file was kept.
Disposal goes to TCEQ
DSHS explicitly points disposal questions to TCEQ. Before you scrap a tube head, a lead-lined cabinet or an old processor, check TCEQ's requirements and keep whatever documentation your vendor provides. Our guide to dental waste disposal covers the streams, and disconnecting dental equipment safely covers removal.
Amalgam separators and wastewater
The federal EPA dental rule at 40 CFR Part 441 applies. If you place or remove amalgam and discharge to a publicly owned treatment works, you need a compliant amalgam separator, you follow the best management practices (no flushing scrap amalgam, no oxidizing line cleaners), and you file a one-time compliance report with your pretreatment control authority, typically the city water utility in Texas. Ask that utility what it wants from a new owner at closing, since EPA does not address transfers. See amalgam separators.
Run the pre-purchase equipment checklist and read the hidden costs of buying used equipment before you commit to a used imaging purchase.
Non-competes and employment
Texas non-competes are governed by Business and Commerce Code Chapter 15. Historically, section 15.50 set special rules for physicians licensed by the Texas Medical Board, and dentists fell outside those protections, leaving them to the general enforceability standard.
That changed in 2025. Senate Bill 1318, passed in the 89th Legislature and effective September 1, 2025, extended the health care practitioner non-compete restrictions to dentists, nurses and physician assistants through section 15.501. According to the Senate Research Center analysis of the enrolled bill, a covered non-compete must:
- Expire no later than the one-year anniversary of the date the contract or employment terminated.
- Be limited to no more than a five-mile radius from the location at which the health care practitioner primarily practiced.
- Include a buyout no greater than the practitioner's total annual salary and wages at the time of termination.
- State its terms clearly and conspicuously in writing.
The analysis also notes that the non-compete is void entirely if the practitioner is involuntarily discharged from the contract or employment without good cause.
Read those four limits together and you can see what a compliant Texas dentist non-compete now looks like: one year, five miles from where you actually worked, and a price to walk away that is capped at one year of your pay. A contract that asks for three years and twenty-five miles is no longer a negotiation posture, it is a drafting problem.
Two cautions. First, we verified these terms from the Legislature's bill analysis rather than from the codified statute text, because the statute site would not render for us. Read Business and Commerce Code sections 15.50 and 15.501 directly, or have counsel do it. Second, new statutes almost always apply prospectively, and whether an agreement signed before September 1, 2025 is covered is exactly the kind of question that turns on the bill's applicability language. Ask a Texas employment attorney about your specific contract rather than assuming.
At the federal level, the FTC's non-compete rule is not in effect. The Commission voted on September 5, 2025 to dismiss its appeals and accede to the vacatur of the rule, so Texas law controls. See our national overview of non-compete agreements for dentists and the associate contract red flags guide.
What we could not confirm
- The codified text of Business and Commerce Code sections 15.50 and 15.501. We verified the SB 1318 terms from the Legislature's own bill analysis because the statute site would not render. Read the sections directly.
- Whether SB 1318 applies to agreements entered into before September 1, 2025.
- The Texas dentist renewal cycle dates. TSBDE publishes the biennial CE requirement but we did not confirm the renewal date pattern.
- DSHS inspection intervals for dental facilities.
- Dental hygienist CE hours in Texas. Confirm from TSBDE directly.
- Sales and use tax treatment of dental equipment in Texas, including private-party purchases. Confirm with the Comptroller and your CPA.
- Texas limits on non-dentist ownership of a dental practice. TSBDE rules govern and the board does not publish a clear summary. Confirm with a dental-specific attorney.
Where to verify
- Texas State Board of Dental Examiners: dentist license renewal, dentist continuing education, jurisprudence assessment, and RDA x-ray certification
- Texas DSHS Radiation Control: dental x-ray machine registration, applications and forms, and Regulatory Guide 4.4 for dental facilities
- Texas Legislature: SB 1318 bill analysis, 89th Legislature and the Business and Commerce Code Chapter 15
- US Environmental Protection Agency: dental effluent guidelines, 40 CFR Part 441
- Federal Trade Commission: September 2025 statement on the non-compete rule
- Texas Comptroller of Public Accounts: comptroller.texas.gov
Putting it to work
If you are signing a Texas associate contract right now, the five-mile and one-year figures are the numbers to bring to the table, and the buyout cap is the number that decides whether you could ever leave. If you are an owner, get your template rewritten by Texas counsel rather than discovering in litigation that your covenant exceeds a statutory cap. On the equipment side, keep your DSHS certificate, machine list and named RSO current, and start RDA x-ray certificates on a new hire's first day.
Related reading: non-compete agreements for dentists, x-ray registration and inspections, the associate contract review checklist, and the rest of the state resources directory.
This guide is educational content and does not constitute legal, financial, tax, or clinical advice. Laws and regulations vary by state and change over time. Consult your own dental-specific attorney, CPA, and state dental board before acting.